I have had a twitch in my right forearm for three months, causing a jerk in my thumb. Since the last two weeks, it has spread to my right leg and the rest of my body. The majority of my right arm is affected. I got an EMG done three months back, which was normal. The muscle twitches increase even after light exercise or when I put pressure. There is no loss of strength, but I have major arm fatigue. When I get ill with the flu, the symptoms are significantly reduced. I am concerned that it is ALS.
I would like to know some details about your symptoms:
Are these twitches visible by eyes, or are they only felt inside?
Have you noticed any situations when these twitches get worse?
Did you notice any thinning of muscle bulk in any limb?
Do you have any weakness in hand grip or lifting any object overhead?
Do you have any difficulty swallowing liquids or solid food?
Do you have any neck or arm pain or tingling?
How is your usual mood in the daytime? Is it happy, sad, or worried?
How is your sleep? How long does it take for you to fall asleep after lying on the bed? Do you wake up in between sleep?
Do you have any other medical problems? Are you on any regular medications? if yes, please mention the names and doses.
Apart from EMG, have you undergone any other investigation? if yes, please send reports as attachments.
Kindly revert with the answers to the above questions.
Regarding follow up:
Revert with the above-mentioned information for better understanding and further judgment.
Thank you for the response.
The answers to your questions are as follows:
Are these twitches visible by eyes, or are they only felt inside? - Yes, the ones in my arms are visible.
Have you noticed any situations when these twitches get worse? - They are not very relevant in the other parts of my body. When I apply pressure, the twitching lasts for days.
Did you notice any thinning of muscle bulk in any limb? There is thinning of muscles in one arm.
Do you have any weakness in hand grip or lifting any object overhead? - No clinical weakness, but both arms get very fatigued and heavy like a dead leg which comes and goes.
Do you have any difficulty swallowing liquids or solid food? - No.
Do you have any neck or arm pain or tingling? - No.
How is your usual mood in the daytime? Is it happy, sad, or worried? - Worried only about twitching.
How is your sleep? How long does it take for you to fall asleep after lying on the bed? Do you wake up in between sleep? - I do not have difficulty falling asleep but have disturbed sleep for around six hours.
Do you have any other medical problems? Are you on any regular medications? if yes, please mention the names and doses. - No.
Apart from EMG, have you undergone any other investigation? if yes, please send reports as attachments. - I got an MRI done three years ago, but the report was normal.
There is one attachment that you have shared (attachment removed to protect the patient's identity) and it is the nerve conduction study findings and not an EMG (electromyography) report. Also, I am curious to know for which medical symptoms you underwent MRI (magnetic resonance imaging) three years ago and MRI of which body part?
As per your description, there is a possibility that you might be having fasciculations. There can be numerous reasons for fasciculations. The common one is benign fasciculation syndrome. Also, it can happen due to anxiety or in a denervated muscle. Other rare causes are cramp-fasciculation syndrome and ALS (amyotrophic lateral sclerosis).
As you have mentioned that there is no clinical weakness in arm strength, but there is a dent in the forearm; it needs to be assessed if it is new or there since before. Also, you need a detailed clinical neurological examination, particularly the deep tendon reflexes. Twitches alone do not point toward ALS. ALS is a progressive disease and, in an early stage, can have only fasciculations. But with time, other signs and symptoms appear. If signs and symptoms fit into ALS diagnostic criteria, only then is ALS diagnosis feasible. Moreover, there is no investigational test to diagnose or rule out the condition. ALS is a clinical diagnosis only after ruling out other possibilities which can mimic those symptoms.
I hope this helps.
Investigations to be done:
I suggest going for physical consultation with a neurologist for a detailed physical, and neurological examination and getting an MRI brain, MRI whole spine, T3 T4 TSH (thyroid stimulating hormone), and serum Vitamin B12 done.
The differential diagnosis is benign fasciculation syndrome, anxiety disorder, or ALS.
Regarding follow up:
Revert with reports and neurological examination findings.
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Same symptoms doesn’t mean you have the same problem. Consult a doctor now!
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